In this article, you will learn about anemia, its severity, causes, symptoms, and physical examination.
Anemia refers to a decrease in the total number of circulating red blood cells with decreased hemoglobin from normal for that age group and gender. In the western population, hemoglobin below 13.2 g / dl in adult males and 11.7 g / dl in adult females is considered anemia. However, the WHO criteria for anemia are as follows:
Adult males = Hb <13 g / dl
Adult women = Hb <12 g / dl
Infants and children up to 12 years
= Hb <11 g / dl
Pregnant women = Hb <11g / dl
Severity of anemia
Some workers classified the severity of anemia based on hemoglobin levels:
Mild anemia: Hb 9.1-10.5 g / dl
Moderate anemia: Hb 6.0-9.0 g / dl
Severe anemia: Hb <6.0 g / dl
In cases of severe anemia, the hyperdynamic cardiac circulatory systems can fail and as a result there is fluid retention leading to edema. Correction of anemia leads to the disappearance of the edema.
This term is used when the concentration of red blood cells decreases due to hemodilution such as in the third trimester of pregnancy; however, it is not a pathological entity, but must be differentiated from anemia.
For a complete understanding of anemia, one must consider the number of red blood cells and hemoglobin.
Hematocrit is a good measure of the degree of anemia.
MANIFESTATIONS OF ANEMIA
The symptomatology of anemia depends on:
- severity of disease contributing to anemia and
- the rate at which the above changes occur.
Most of the clinical manifestations are due to compensatory features induced by hypoxia. Most deficiency anemias (Fe, B12, folic acid) in India are of insidious onset and therefore the patient’s physiological adjustments adapt to the gradual decline in hemoglobin and the patient may not seek medical attention. until hemoglobin drops as low as 7g / dl.
- Dyspnea: Dyspnea and palpitations, more so on exertion, are common complaints of patients with moderate to severe anemia. These patients may also present with intermittent claudication and angina pectoris. Systolic murmurs are not uncommon in severe anemia.
Pallor: Pallor is the most obvious feature of anemia. It is best detected in the conjunctiva, the mucous membrane of the tongue / lips and nails. Palms turn pale The pallor associated with scleral jaundice suggests hemolytic anemia.
CNS signs: Patients with severe anemia may complain of headaches, dizziness, tinnitus, lack of concentration and muscle weakness.
Glossitis: In severe anemia, there is atrophy of the papillae of the tongue, glossitis, stomatitis, and cracks at the corners of the mouth.
- ECG changes: In severe anemia, there is ST segment depression and T wave inversion. These changes go away as hemoglobin increases after treatment.
ANEMIC PATIENT ASSESSMENT
It is important to identify the factors that led to the anemia and then to treat them. To assess the case, the following steps are required:
1. History and clinical examination
2. Haematological examinations
3. Investigations (other than haematological).
Some important information regarding the etiology of anemia is taken from history, for example. age
- onset of symptoms – acute or insidious.
- any history of taking medication, exposure to chemicals.
- family history of similar illness. patient occupation.
- symptoms of glossitis, stomatitis.
- history of hematuria, hematemesis, tarry stools.
- In women, story about the amount of blood lost during menstruation.
- diet history in relation to iron, lives. B2, folic acid content, cooking food.
- history suggestive of jaundice.
- urine color – whether dark yellow, tall or cola.
- history of bleeding tendency in the form of petechiae, bruising, etc.
- stools, if large, suggesting malabsorption syndrome.
- Paleness-conjunctival, tongue, skin
- Nails – for platonychia / koilonychia
- Signs of infection / bleeding due to neutropenia / thrombocytopenia.
- Cardiac assessment for murmur / rheumatic carditis
- Thoracic examination for tuberculosis, infection, bronchiectasis, etc.
- Kidney assessment for chronic kidney disease.
- Signs of various systemic diseases.
SURVEYS REQUIRED FOR ANEMIA ASSESSMENT
• Number of red blood cells
• Red blood cell indices-MCV, MCH. MCHC, RDW
• Number of reticulocytes
• Morphology of red blood cells on a stained peripheral blood smear
• Differential number of leukocytes
• Number and morphology of platelets
• Number of leukocytes
- Assessment of bone marrow, assessment of iron stores in bone marrow
• Other investigations for hemolytic anemia
• Saturation of serum iron, ferritin and transferrin
• Color, pH, density
• Proteins, sugar, ketones
• Bilirubin, urobilinogen
• Microscopic examination of red blood cells-hematuria
• Occult blood
• Examination of eggs and cysts
4. Other investigations
• Blood urea nitrogen, S. creatinine
• S. Bilirubin, SGOT, SGPT, S. alkaline phosphatase
• Studies on barium for gastrointestinal lesions of the esophagus / stomach / small or large intestine according to history and clinical features.
• Ultrasound of the abdomen for any mass, kidneys, spleen and liver.
• Scanner / MRI in case of suspected malignant tumors.
• Liver function tests
This content is accurate and true to the best of the author’s knowledge and is not a substitute for the diagnosis, prognosis, treatment, prescription and / or dietary advice of a licensed healthcare professional. Drugs, supplements, and natural remedies can have dangerous side effects. If pregnant or breastfeeding, consult a qualified provider on an individual basis. Seek immediate help if you experience a medical emergency.
© 2021 Sanju
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